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    Please use this identifier to cite or link to this item: http://ir.cnu.edu.tw/handle/310902800/30999


    標題: Establishing predictors for successfully planned endotracheal extubation
    作者: Lai, Chih-Cheng
    Chen, Chin-Ming
    Chiang, Shyh-Ren
    Liu, Wei-Lun
    Weng, Shih-Feng
    Sung, Mei-I
    Hsing, Shu-Chen
    Cheng, Kuo-Chen
    貢獻者: Chi Mei Med Ctr, Dept Intens Care Med
    Chi Mei Med Ctr, Dept Intens Care Med
    Chi Mei Med Ctr, Dept Internal Med
    Dept Chia Nan Univ Pharm & Sci
    Kaohsiung Med Univ, Dept Healthcare Adm & Med Informat
    Chung Hwa Univ Med Technol, Dept Safety Hlth & Environm Engn
    關鍵字: extubation
    mechanical ventilation
    predictor
    日期: 2016-10
    上傳時間: 2018-01-18 11:39:33 (UTC+8)
    出版者: Lippincott Williams & Wilkins
    摘要: The aim of this study was to establish predictors for successfully planned extubation, which can be followed by medical personnel. The patients who were admitted to the adult intensive care unit of a tertiary hospital and met the following criteria between January 2005 and December 2014 were collected retrospectively: intubation > 48hours; and candidate for extubation. The patient characteristics, including disease severity, rapid shallow breath index (RSBI), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), cuff leak test (CLT) before extubation, and outcome, were recorded. The CLT was classified as 2+ with audible flow without a stethoscope, 1+ with audible flow using a stethoscope, and negative (N) with no audible flow, even with a stethoscope. Failure to extubate was defined as reintubation within 48hours. In total, 6583 patients were enrolled and 403 patients (6.1%) had extubation failures. Male patients dominated the patient cohort (4261 [64.7%]). The mean age was 64.516.3 years. The overall in-hospital mortality rate was 11.3%. The extubation failure rate for females was greater than males (7.7% vs 5.3%, P<0.001). The group of patients who failed extubation were older (66.7 +/- 14.4 vs 64.3 +/- 16.4, P = 0.002), had higher APACHE II scores (16.8 +/- 7.6 vs 15.9 +/- 7.8, P = 0.023), lower coma scales (10.3 +/- 3.7 vs 10.8 +/- 3.7, P = 0.07), a higher RSBI (69.9 +/- 37.3 vs 58.6 +/- 30.3, P<0.001), a lower MIP, and MEP (-35.6 +/- 15.3 vs -37.8 +/- 14.6, P = 0.0001 and 49.6 +/- 28.4 vs 58.6 +/- 30.2, P<0.001, respectively), and a higher mortality rate (25.6% vs 10.5%, P<0.001) compared to the successful extubation group. Based on multivariate logistic regression, a CLT of 2+ (odds ratio [OR] = 2.07, P<0.001), a MEP 55cmH(2)O (OR = 1.73, P<0.001), and a RSBI<68breath/min/ml (OR = 1.57, P<0.001) were independent predictors for successful extubation.This study identified 3 independent risk factors for successful extubation after a successful breathing trial, including a CLT of 2+, a MEP 55cmH(2)O, and a RSBI < 68breath/min/ml. Furthermore, a nomogram integrating these 3 parameters, which represented the combined consideration of the upper airway patentency, cough strength, and respiratory capacity, was developed to better predict extubation success.
    關聯: Medicine, v.95 n.41, e4852
    Appears in Collections:[通識教育中心] 期刊論文

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